Hematologic Oncology Update, Issue 1, 2016 (Video Program)Management of T-cell lymphomas
3:58 minutes.
TRANSCRIPTION:
DR LOVE: Can you talk a little bit about what we know about B vedotin in T-cell lymphoma, including anaplastic large cell lymphoma? DR YOUNES: Let’s start with anaplastic large cell lymphoma because this is one of the initial indications, approval by the FDA. It’s a very high response rate, a little bit even higher than the Hodgkin lymphoma, 80-something-percent response rate, very highly active. And it didn’t matter whether you have an ALK-positive or ALK-negative. So the negative prognostic factor of ALK-negative disease, it did not matter when you treat them with brentuximab vedotin. And there’s excitement about then adding brentuximab vedotin to front-line regimens, substituting the vincristine with brentuximab in the CHOP or CHOEP backbone. And this randomized trial completed enrollment, and it will be interesting to see what will come out of this randomized trial. In common variety T-cell lymphoma, there is also expression of CD30 to a variable degree. It seems that the level of CD30 expression, it did not correlate with responses, although as a group of patients with T-cell lymphoma — that is different from anaplastic large cell lymphoma — the overall response rate, it’s much lower compared to anaplastic large cell lymphoma. Anaplastic, we said about 80-something response rate, and peripheral T-cell lymphoma not otherwise specified, in the 30% response rate. DR LOVE: From your point of view, are these clinically meaningful responses? DR YOUNES: Yes. I mean, for the individual patient, of course, clinically meaningful responses. DR LOVE: How are you approaching up-front therapy of peripheral T-cell lymphoma not otherwise specified? DR YOUNES: This is another area of really evolving concepts. The standard of care up until recently was CHOP and then became a CHOEP based on retrospective analysis of the German Hodgkin Lymphoma Study Group that included both B cells and T cells. And when we look back to see the outcome based on B versus T, it seems like some of the patients with T cells benefited from the CHOEP compared to the CHOP in the context of a randomized study, and we saw that “they’re performing.” Predominantly, patients who benefited from the etoposide were actually the anaplastic large cell lymphoma anyway. So based on this data and because not much was going on for this disease, everybody jumped on the CHOEP as an option for standard of care as initial induction therapy. Then our colleagues from Denmark did a Phase II trial where they took patients who were treated with induction therapy, CHOP or CHOEP, and then for those who achieved a CR then consolidated them with autologous transplant and showed if you do that as a package, probably about 50% or so would have a long-term progression-free survival. And again, everybody got excited — not a randomized trial — that there’s not a single randomized trial, actually, looking at the role of autologous transplant in peripheral T-cell lymphoma. But for the lack of other good news, I think most oncologists jumped on this. And they now offer patients CHOP or CHOEP, and if you achieve a CR, you take them to autologous transplant. DR LOVE: What about management of later-stage disease? I’m curious how you incorporate drugs like pralatrexate, romidepsin and belinostat in your practice. DR YOUNES: So these are options all approved by the FDA for relapsed T-cell lymphomas regardless of the subtype. I think most of us would use with histone deacetylase inhibitors. And there’s no preference. Again, there are no rules on which one you start with. I think you can choose either belinostat or romidepsin. Both are fine. The face value, they look equivalent. They’re given in different schedules, of course, but they both look fine. Pralatrexate, I think it’s a little bit more tough to give. And I think most of us would use it in later lines of therapy, even though it doesn’t make sense. Because if you delay it for later lines of therapy, the efficacy probably would be less, but because of the difficulty of giving it and so forth, I think most of us would keep it for later lines of therapy. |